Local doctor fighting cancer taken aback by drug bill: Each treatment costs $44,000 at Dover hospital

Thursday

Apr 4, 2013 at 3:15 AMApr 4, 2013 at 6:44 AM

By Liz Markhlevskayalmark@fosters.com

ROCHESTER — A year ago, city physician Dr. Terry Bennett was diagnosed with cancer.

Since the diagnosis, his cancer has been controlled by various medications that attacked his cancer cells and healthy cells alike. As a result, he has been struggling with fatigue, loss of hair, and swelling of his leg.

But a promising new drug recently approved by the Food and Drug Administration appears to be the solution for treating Bennett's cancer without the debilitating symptoms that makes him feel “sick as a dog,” he said.

The problem is, the new drug that's now open for public use, Kadcyla, also known as TDM-1, comes with a high cost, Bennett said.

Bennett, 74, recently received his first IV of the medication, and Wentworth-Douglass Hospital in Dover charged him close to $44,000 for the treatment. The medication is supposed to be administered every three weeks, and for each treatment, Bennett is expecting a similar bill.

At the same time, Genentech, the company that developed the drug, only charges $9,800 a month for Kadcyla, according to Genentech spokeswoman Susan Wilson. That means Wentworth-Douglass charged approximately $34,200 more for the treatment than Genentech charges.

Noreen Biehl, vice president of community relations at Wentworth-Douglas Hospital, said there are several factors that go into the mark-up for the medication.

Some of the extra cost goes to cover the patient assistance program the hospital offers for uninsured and underinsured patients, said Biehl. The mark-up also makes up for patients who just don't pay their bills — a problem at many hospitals, said Biehl — as well as other operational costs to keep the hospital running.

Biehl emphasized Wentworth-Douglas is a nonprofit hospital, which treats all patients regardless of their ability to pay.

“We treat all patients who come,” she said.

All treated patients get billed for treatment, unless they qualify for the assistance program, which typically requires patients to be at 200 percent of the poverty level, said Biehl.

Bennett, talking to Foster's after receiving his treatment, said he has no plans to pay his bill for the Kadcyla treatment.

“I'm going to see what happens,” said Bennett. “This is very distressing ... If they come after me, they won't like the publicity it results in.”

He added that $44,000 is an unreasonable amount to charge for cancer medication, and most cancer patients can't afford it.

“Why the (heck) would they mark this up ... if they know they're not going to get it?” said Bennett. “It doesn't seem kind at all.”

Bennett said he's been notified that Medicare would cover $9,000 of his treatment, but that has not yet been confirmed. His Anthem Blue Cross Blue Shield insurance does not cover medication costs.

Foster's contacted a number of hospitals in the Seacoast and within a 100-mile radius of the region to ask what they charge for treatment with Kadcyla. None of the institutions contacted would say what they charge. A public relations spokeswoman at Dartmouth Hitchcock in Hanover said that while patients there can get Kadcyla, the cost involves a variety of factors and is too complex for them to quote a price to the newspaper.

Christine Kenney, spokeswoman for Lahey Clinic, said that her hospital does not yet use Kadcyla and has no experience with it.

Anne Doerr, media manager at Dana Farber in Boston, did not respond to questions about Kadcyla and its pricing of the drug. She promised to look into it, but thus far has not come back with information. Foster's got a similar response from Frisbie Memorial Hospital in Rochester.

Foster's also made inquiries to Exeter Hospital. The billing specialist there did not return a phone call.

Foster's also tried to reach a number of medical experts to talk about Kadcyla and what hospitals are charging for it, but so far, none of those contacted have returned phone calls.

Kadcyla, approved by the FDA on Feb. 22, treats cancer characterized by the HER-2 protein, which promotes cancer growth. HER-2 positive cancers typically occur in young women with breast cancer, but can also occur in other types of cancers as well. Bennett's HER-2 positive cancer is Ampullary adenocarcinoma, targeting his biliary tract, the common anatomical term for the path by which bile is secreted by the liver then transported to the first part of the small intestine.

HER-2 positive cancer tends to be more aggressive than other types of cancer.

The newly released drug is a combination of Herceptin and a chemotherapy toxin. Herceptin specifically targets HER-2 positive cells, while the chemotherapy agent kills those cells.

Because the toxicity is targeted, “It's a long-awaited magical solution,” said Bennett.

In fact, during a clinical trial that was the basis of FDA approval, patients using Kadcyla lived six months longer that those using standard therapy, said Genentech spokeswoman Susan Wilson. Those patients also experienced fewer severe symptoms, she said.

“We have seen a lot of enthusiasm for this medicine from patients, specifically from patients who have this type of breast cancer that's HER-2 positive,” she said.

Wilson said Genentech also offers a patient assistance program to help eligible patients pay for their treatment. Those with no health insurance can qualify for free medication.

When it comes to determining the cost of a drug like Kadcyla, Genentech takes into account factors such as effectiveness of the drug; whether other medications can be used to treat the same disease; and the amount of money that would be required to discover other drugs to treat life-threatening diseases, said Wilson. Genentech also takes into account ensuring necessary medication goes to patients who can't afford it, she said.

Wilson said that while Kadcyla is now only available in the United States, the Roche Group, which owns Genentech, has applied to have the medication available in Europe.